For most general dentists, especially the recent graduate, the idea of treating children can create a certain level of stress and anxiety. Although most practitioners may have received some didactic training during their dental school experience with regards to principles of tooth eruption, space maintenance, and management of children, their clinical experience is limited. This often creates a feeling of intimidation when asked to provide dental care to the pediatric population. The best way for young practitioners to gain experience in working with children is to be open minded and being familiar with AAPD policies and guidelines. In addition, reaching out to local pediatric dental faculty could be an additional resource when faced with particularly challenging cases.

A general dentist has one chance to create a good first impression of dentistry to a child (Fig. 16.1). The success of this interaction usually determines the outcomes of subsequent dental visits. For example, children can sense if their dentist is uncomfortable and this may inadvertently create mistrust between the child and the dentist. Depending on the age and cognitive development of the child, this distrust can manifest in the form of a refusal to cooperate, crying, and an adverse behavioral pattern, even with the simplest procedures. The authors recommend that the new practitioner review the AAPD policy guidelines on behavioral modification techniques. This can be accessed on ISSN: http://​www.​aapd.​org/​media/​policies_​guidelines/​g_​behavguide.​pdf (Accessed on March 30, 2016).

Be confident when you speak to kids and remember that you are the adult and authority figure at that appointment. It is important to understand that not all children are the same nor will they behave the same. Greet them in a friendly manner and asses what type of child is sitting in your dental chair. Also try to engage the parents early to enquire about their child’s past dental experience. Some practitioners categorize children by the level of fear and their response to fear.

When speaking with children about impending dental treatment, a general dentist should be careful to use language that creates a positive mind-set. The dentist must gauge the child’s cognition and use “kids-friendly” words to convey their “dental” message in order to build and maintain trust. Depending on the age of the child, using words like needle, shot, drill, pull, or yank teeth or any other word that suggest unpleasantness and invoke fear must be avoided. Here are some suggestions (Table 16.3).

This behavior-shaping tool is well accepted and very popular with children and adult patients (Fig. 16.2).

This is considered an expansion of the Tell-Show-Do technique. Here stimuli with the least anxiety are presented first. Higher anxiety evokers are presented as the child is able to tolerate them, e.g., using a prophylaxis cup before using a high speed handpiece (Fig. 16.3).

This is a technique used to reward desirable positive behavior by praising the child or providing a reward and this further strengthens the recurrence of such behavior in future. Many dental offices have small prizes to give to pediatric patients at the end of the visit such as stickers and simple toys. Other social reenforcers include positive voice modulation, e.g., being “goofy,” facial expression, verbal praise, and appropriate physical demonstrations of affection by all members of the dental team.

This is a technique of diverting the patient’s attention from what may be perceived as an unpleasant procedure or sensation by focusing their thoughts on something other than what is being done. Examples include asking patient to wiggle his or her toes during impression taking; giggle the cheeks during local anesthetic injection; and giving patient storytelling, animated voices, or even a short break during a stressful procedure.

This technique is very effective in families that have two or more children. A younger, inexperienced, or apprehensive child learns to stay calm and how to act properly by watching an older sibling or someone they look up to (Fig. 16.4),

Here, the dentist uses a controlled alteration of voice volume, tone, or pace to influence and direct the child’s behavior. It may be uncomfortable for new dentists since it is not learned in dental school. It takes time and experience to develop; the facial expression is as important as voice, and it is important to explain this technique to parents beforehand to prevent misunderstanding the dentist or assistants for being “mean” to their child.

There must be a discussion and agreement between the dentist and parent before the child sits in the chair. Parents of children >3 years that come into the operatory must be prepared to leave if/when child shows undesirable behavior. Generally children under 36–40 months do better with parents present. The behavior and attitude of a parent can be directly related to a good or a bad dental visit for their child. Children can sense their parents’ fear and parents can unintentionally transfer fear to their child by their body language or nonverbal cues. It cannot be perceived by either the parent or child as punitive. Sometimes, a dentist can use parents as leverage to obtain appropriate behavior response. First, explain the procedure to the parents separately. During the procedure, if the child shows negative or undesirable behavior, the parents are asked to leave the operatory immediately. Once the child’s behavior improves, the parents can return to the room.

Using fluoride for the prevention and control of dental caries is proven to be both safe and effective when dosed appropriately (AAPD 2014b). The frequency of fluoride exposure from various sources should be identified when formulating a dental plan for the patient. Fluoride sources could include water, dietary supplements, mouth rinses, and toothpaste. Prior to prescribing supplemental fluoride to any child, initial testing of the drinking water should be performed. A caries risk assessment is also essential in order for proper parental counseling to reduce the child’s caries risk (See Chap. 3 Caries Prevention) (Table 16.4, Fig. 16.5).

Dosage of local anesthetic in pediatric patients should be measure by the child’s body weight. Children do not have fully developed livers which slow down metabolism of certain anesthetics. Use caution in the amount of anesthetic you give and never exceed the maximum total dosage based on the child’s weight (Table 16.5).